Prolonged intermittent home video-EEG monitoring for drug-resistant epilepsy: the cost-availability model

Video-EEG monitoring (VEM) is an obligatory step in drug-resistant epilepsy (DRE) management. The common way of VEM is in-hospital VEM (IVEM), which is limited by the need to admit the patient to the epilepsy monitoring unit. Prolonged intermittent home VEM (PIHVEM) can be a more available alternative. Since reducing antiseizure medication at home is impossible, PIHVEM can be associated with long monitoring and, therefore, relatively high cost. To regulate the parameters of PIHVEM (the patient selection criteria and length of PIHVEM), we introduce the cost-availability model (CAM), which balances the VEM availability and VEM cost, considering the ratio between the annual number of VEM studies performed for DRE and annual DRE incidence (VEM DRE/VEM incidence). The lowest CAM value corresponds to the most optimal parameters of PIHVEM. CAM value decreases with longer PIHVEM. With a lower VEM DRE/VEM incidence ratio, CAM value reduction can be achieved by including patients with lower seizure frequency in PIHVEM. In such a situation, the considerations of VEM availability outweigh the VEM cost. With the increase in VEM DRE/VEM incidence ratio, the influence of VEM cost increases relative to VEM availability. The conclusions: PIHVEM can increase VEM availability without increasing the cost, and CAM can estimate the optimal PIHVEM parameters.